Pigmented sweat gland tumor mimicking melanoma.

Eccrine poroma, a common adnexal neoplasm, usually presents as a solitary, smooth, flesh-colored nodule on the foot or hand. Eccrine porocarcinoma is extremely rare and much more variable in its morphology and location. Both tumors can contain melanocytes and melanin. We describe a patient with an enlarging, eroded brownish black nodule on his shoulder. Examination of a biopsy specimen showed it to be derived from acrosyringium and to contain abundant melanin and scattered dendritic melanocytes. Eccrine poroma and porocarcinoma should be considered in the clinical differential diagnosis of pigmented tumors.

Rhinophymalike metastatic carcinoma.

Cutaneous metastases from internal carcinoma vary in their clinical appearance. An unusual presentation, initially resembling rhinophyma, is described in a 71-year-old man with lung cancer. The clinical variations of metastases to skin are reviewed.

Papular mucinosis and human immunodeficiency virus infection.

Cutaneous mucin deposition occurs both as an isolated phenomenon and in patients with various systemic disorders. Among these are endocrinopathies (eg, hypo- and hyperthyroidism), malignancy (mycosis fungoides), connective tissue disorders (lupus erythematosus), and infectious diseases (scleredema associated with upper respiratory tract infection). We present a case of papular mucinosis in a patient infected with the human immunodeficiency virus. This case represents the third report of these disorders coexisting.

Trivial or terrible? The psychosocial impact of psoriasis.

BACKGROUND: Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. METHODS: The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment. RESULTS: Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well. CONCLUSIONS: Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.

Relapsing polychondritis: case report and review of the literature.

A 65-year-old man who experienced the acute onset of pain, redness, and swelling of his right ear was treated with antibiotics for erysipelas. Subsequently, the other ear and both eyes became inflammed. Relapsing polychondritis was diagnosed and treatment with prednisone was successful. Relapsing polychondritis, a rare multisystem disease, presents most commonly with auricular chondritis. Other clinical manifestations include arthritis, nasal chondritis, scleritis, damage to tracheal and bronchial cartilage, and aortic, cardiac, and renal involvement. The cause is autoimmune. Recurrent episodes of progressive inflammation result in destruction of cartilage. Treatment consists of administration of corticosteroids and other anti-inflammatory and immunosuppressive drugs.

Paraneoplastic pemphigus appearing as bullous pemphigoid-like eruption after palliative radiation therapy.

Paraneoplastic pemphigus is a recently described disease in which patients have polymorphous skin lesions suggestive of both erythema multiforme major and pemphigus vulgaris in association with internal neoplasms, especially non-Hodgkin's lymphoma. These patients have characteristic autoantibodies that bind specific epidermal proteins. A Nikolsky-negative bullous pemphigoid-like eruption developed within the radiation therapy field in a 72-year-old man receiving palliative treatment for recurrent large cell lymphoma. The eruption rapidly progressed to a Nikolsky-positive bullous process more typical of pemphigus vulgaris with extensive involvement of respiratory epithelia. Despite aggressive treatment with high-dose corticosteroids and antibiotics, the patient rapidly succumbed. Results of immunofluorescence studies and autopsy findings confirmed the diagnosis of paraneoplastic pemphigus.

Subcutaneous nodules of the scalp: preoperative management.

The differential diagnosis of subcutaneous lesions of the scalp is extensive and includes many tumors with intracranial and intraosseous extension. The vast majority of lesions seen by the dermatologist will be benign. However, certain lesional characteristics increase the likelihood of a serious disorder and these must be evaluated preoperatively. We review the important features of subcutaneous scalp lesions and suggest a systematic approach to diagnosis based on patient age, lesion morphology, location, and radiographic findings.